Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START

Purpose: To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need. Methods: In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content. Results: Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018–March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Conclusion: TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults’ health. © 2020, © 2020, The Author(s)

A comparative ID migraine™ screener study in ophthalmology, ENT and neurology out-patient clinics

Migraine is more likely to be misdiagnosed in patients with comorbid diseases. Not only primary care physicians, but also specialists might misdiagnose it due to the lack of diagnostic criteria awareness. The ID migraine test is a reliable screening instrument that may facilitate and accelerate migraine recognition. This study aimed to compare the prevalence and characteristics of migraine in a large sample of patients admitted to clinics of ophthalmology (OC), ear, nose and throat diseases (ENTC) and neurology (NC), as well as to validate the use of the ID migraine test in OC and ENTC settings. This was a multicentre (11 cites) study of out-patients admitting either to NC, ENTC or OC of the study sites during five consecutive working days within 1 week. From each of the clinics, 100 patients were planned to be recruited. All recruited patients were interviewed and those having a headache complaint received an ID migraine test and were examined for headache diagnosis by a neurologist, blinded to the ID migraine test result. A total of 2625 subjects were recruited. Only 1.3% of OC patients and 5.4% of ENTC patients have been admitted with a primary complaint of headache, whereas the percentage of NC patients suffering from headache was 37.6%. Whereas 138 patients (19.3%) in OC, 154 (17.3%) in ENTC and 347 (34%) in NC were found to be ID migraine test positive, 149 patients (20.8%) in OC, 142 (16%) in ENTC and 338 (33.1%) in NC were diagnosed with migraine. The sensitivity, specificity, and positive and negative predictive ratios of the ID migraine test were found to be similar in all clinics. An important fraction of the patients admitted to NC, as well as to OC and ENTC, for headache and/or other complaints were found out to have migraine by means of a simple screening test. This study validated the ID migraine test as a sensitive and specific tool in OC and ENTC, encouraging its use as a screening instrument. © Blackwell Publishing Ltd.This study was supported by an unrestricted research grant made by Pfizer-Turkey. The authors wish to thank the researchers the names of whom are listed below: MIRA-3 study group Name of the study centre Investigators 1. Sutcu Imam University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Deniz Tuncel 1 , Mustafa Gokce 1 Gokhan Ozdemir 2 , Mehmet Akif Kilic 3 2. Ege University Medical Faculty, Department of Neurology 1 Department of Eye Diseases 2 , Department of ENT Diseases 3 Bilge Cetin 1 , Figen Gokcay 1 , Hadiye Sirin 1 3. Ataturk University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Orhan Deniz 1 , Recep Demir 1 , Ibrahim Kocer 2 , Bulent Aktan 3 4. Dokuz Eylül University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Vesile Ozturk 1 , Fethi Idiman 1 , Gokhan Gurel 1 , Fusun Boyacioglu 1 5. Uludag University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Necdet Karli 1 , Cigdem Cavdar 1 , Mehmet Zarifoglu 1 6. Abant Izzet Baysal University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Nebil Yildiz 1 , Sule Aydin 1 , Nazire Dogan 1 , Tolga Beyazit 1 7. Istanbul University Cerrahpasa Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Aksel Siva 1 , Sabahattin Saip 1 , Baki Göksan 1 , Selim Gokdemir 1 , Idris Sayilir 1 8. Ankara Numune Education and Research Hospital, Department of Neurology 1 , Department of ENT Diseases 3 Fikri Ak 1 , Gurdal Orhan 1 , Aysegul Akagunduz 1 , Mustafa Kaymakçi 3 9. Dicle University Medical Faculty, Department of Neurology 1 , Department of ENT Diseases 3 Mediha Yalman 1 , Ufuk Aluçlu 1 10. Mustafa Kemal University Medical Faculty Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Taskin Duman 1 , Ismet Murat Melek 1 , Cengaver Tamer 2 , Huseyin Oksuz 2 , Ali Safak Dagli 3 , Ertap Akoglu 3 11. Firat University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Serpil Bulut 1 , Sait Berilgen 1 , Caner Demir 1 , Meliha Aydin Ulger 1 -

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically